Should You Get Dermatological Photography?

Freckles and moles are part of the job for dermatologists. Their ability to remember, from one visit to the next, whether the spots on a patient’s back have stayed the same might seem like a mystery. It turns out they don’t have to remember — that’s what dermatological photography, also known as total-body photography, is for.

I’m very freckly, and I’ve had several atypical moles biopsied over the years. Total-body photography documents all the moles on your skin to help doctors keep track of changes. It’s useful, and sometimes critical, but it’s also not something that everyone needs.

“This is for someone who’s at increased risk of melanoma,” says Dr. Douglas Grossman, a dermatologist, University of Utah professor and investigator at the Huntsman Cancer Institute. “They either have numerous moles or atypical moles that are risk factors for melanoma that need to be monitored.”

Whether or not you should have total-body photography depends on several factors, including your risk level for melanoma and your dermatologist’s opinion. Cost can also be a prohibitive factor; health insurance typically doesn’t cover the service, which can cost anywhere from $250 to $400 or higher, says Dr. Jennifer Stein, a dermatologist and associate professor at the NYU School of Medicine. If you meet the criteria below, however, it may be something worth asking about.

How it works

Total-body photography, which began picking up steam in the early 2000s, is primarily reserved for adults age 20 and over. Teens and children aren’t candidates because they’re still developing new moles, and melanoma is exceedingly rare before adulthood.

Who takes the images varies by practice. Some academic centers have medical photographers who do total-body photography. In small towns or other places where medical photographers aren’t available, a medical assistant might be trained to shoot images, or your dermatologist may send you to a professional photographer. During a photo session, you’ll need to disrobe completely, so that the images document every inch of your skin, although some centers may allow you to wear underwear. Some centers don’t take photos of the genital area unless there are moles present.

Scopes

The photographer will take about 25 pictures, focusing on different body parts, and you’ll receive the photos as prints and/or digital images. Your dermatologist will ask you to bring your images to appointments, so she can compare your skin to the photos to see how your moles have changed or stayed the same over time. (Doctors typically prefer that patients keep their photos in their possession at all times, so they don’t have to keep the sensitive images in the office. Some digital images include HIPAA security features, which should give patients peace of mind when their photos are viewed on a physician’s computer.) Your doctor can also show you how to use the images for at-home self-checks.

If you live near one of a handful of academic or cancer centers nationwide with more advanced photography systems, you may have a different experience: Somesystems can create one continuous image of your skin, rather than snapshots of different sections. You stand with your legs straddled and your arms lifted away from your torso, so that your skin is optimally exposed, and the machinery documents your skin from multiple angles.

Benefits of total-body photography

Your dermatologist might take photos of specific suspicious moles during an appointment to note if they change. Total-body photography is the next level up — a more comprehensive way for a derm to keep track of your entire body and notice subtle changes early.

“The whole point of total-body photography is that you’re prepared for a melanoma that can arise anywhere on the skin, not just from the moles,” Grossman says. “Most melanomas arise de novo, not from a preexisting mole, so if you’re only focused on the moles, you’re going to miss the new lesions that could be melanoma.”

For high-risk patients, total-body photography might prevent unnecessary biopsies.Research by Grossman has shown that people at risk of melanoma who were monitored by total-body photography had nearly five times fewer biopsies of questionable moles, compared to their previous monitoring methods.

Photographic evidence helped me avoid an unnecessary biopsy. My dermatologist wanted to biopsy a suspicious-looking mole near my neckline. My total-body photography images were too new to help her determine if the spot had always looked that way. Fortunately, I remembered that a headshot taken on my wedding day showed the same mole. When I shared the image with my dermatologist (the mole looked exactly the same, 10 years earlier), she agreed that it wasn’t necessary to biopsy.

Comparing photos over time and taking follow-up images as needed may help catch melanoma early, particularly among people at high risk, according toresearch.

“Some people have lots of moles and atypical moles, which means it’s hard to tell the difference between a funny-looking mole and an actual melanoma,” says Stein, who co-authored the study. “All of those moles can act as a camouflage for an actual melanoma.”

Otherresearch found that total-body photography can decrease patient anxiety about melanoma risk.

“Some patients are so anxious about melanoma, they won’t even look at their skin,” Stein says. “You can really reassure them with the photos. They can refer back to the photos and see that it’s not changing and feel better.”

Not every dermatologist is a fan of TBP. It’s a personal preference, according to Stein. And dermatologists who do use TBP vary in how they incorporate the practice into care. Some will rely entirely on it, while others may use total-body images as a general reference point and then also take close-up photos of any concerning moles.

Apps for skin monitoring

If you can’t afford total-body photography or your dermatologist doesn’t recommend it, you might consider using an app to monitor your skin. More than half of the available skin-monitoring apps allow you to take at-home total-body photography images, but you shouldn’t put too much stock in them. Some of these apps are affiliated with dermatology departments or cancer centers, and they’re probably the most reliable. But a recentstudy found that more than half of skin-monitoring apps weren’t created with input from dermatologists, and varied considerably in their effectiveness as cancer-screening tools. There’s no system in place to ensure that apps are safe and effective, and many are not HIPAA-compliant. There are also no quality standards for the algorithms used to determine whether moles look suspicious. You may get false-positive or false-negative results, causing unnecessary worry or delayed treatment.

“These apps are functioning as diagnostic devices, but they do not have validation studies showing how accurate they are or are not,” says study author Dr. Laura K. Ferris, a dermatologist and associate professor at the University of Pittsburgh. “This is a problem, as the prognosis for melanoma — the deadliest skin cancer — is very good when caught early and dismal when caught late. So delays in care can mean the difference between life and death.”

Mole-tracking apps are better than diagnostic apps; they may help you monitor moles between dermatologist appointments. The photos you take might not be as high-quality as those shot by professionals, but they can still help you document changes.

“If a patient came in and showed me a photo of a mole that they took at home six months ago and it had changed, I would certainly take that seriously and would use that information in my medical decision-making,” Ferris says.

But if you download one of these apps, don’t use it as a substitute for medical care: See your dermatologist as often as they recommend if you have risk factors for skin cancer, and perform regular skin self-checks on your own.

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For people with irritable bowel syndrome, it’s common to hear that symptoms such as cramping, alternating diarrhea and constipation, and bloating are “all in their head.” In the case of IBS, there’s actually some truth to this.

It’s not that their symptoms don’t exist. IBS is a very real disorder, and managing its physical toll often becomes an all-consuming effort. The litany of concerns that accompany so many activities — always scouting the closest bathroom, making sure you can reach it in time, farting in public — keeps many people with IBS from having a social life.

Yet according to some experts, IBS is not solely about what’s going on in the digestive system; rather, the brain exacerbates the condition. “IBS is a disorder of brain-gut dysregulation,” explains GI psychologist Sarah Kinsinger, who is also co-chair of the psychogastroenterology section of the Rome Foundation. Accordingly, addressing the “brain” side of IBS through cognitive behavioral therapy with a trained psychologist may help decrease both the anxiety that’s often associated with the disorder and its physical symptoms.

“CBT really should be the first-line treatment for people with IBS. It’s the treatment with by far the most empirical support, and when done well, it can be curative,” says Melissa Hunt, associate director of clinical training in the psychology department at the University of Pennsylvania.

In a series of trialspublished last year, researchers in the UK compared the standard treatment for IBS (typically diet and lifestyle modifications and/or medication) with eight sessions of CBT delivered over the phone or online. Before and after the trials, participants answered questionnaires designed to measure their anxiety, depression and ability to cope with their illness. Two years after the trials, 71 percent of the phone-CBT group and 63 percent of the online-CBT group reported clinically significant changes in their IBS symptoms. Meanwhile, less than half of the standard-treatment group reported such an improvement. Those who did CBT also exhibited lower levels of anxiety and depression and higher coping ability than other participants.

In an earlier meta-analysis (a study of studies), published in 2018 in the Journal of Gastrointestinal and Liver Diseases, a different team of researchers also found that CBT appeared to reduce both psychosocial distress and the severity of IBS symptoms, with a greater effect on the physical symptoms than on the mental ones.

Explainers

The brain-gut connection

How this happens is not completely clear at this point, but it’s believed to have something to do with how the gut and brain communicate.

“IBS is thought to be a disorder of centralized pain processing,” Hunt explains. “There is miscommunication between the pain centers in the brain and the nerves in the gut. In people with IBS, pain signaling gets inappropriately amplified.” Discomfort that wouldn’t even register in the majority of people feels like being stabbed in the gut to a person with IBS. “The best way to address that is to find ways to help reduce pain signaling, and that’s with a psychologist,” Hunt says.

CBT for IBS entails learning relaxation techniques, such as diaphragmatic breathing and progressive muscle relaxation, which help reduce the “volume” of the pain signals by activating the parasympathetic nervous system, i.e., the body’s “rest and digest” response. “This can also lead to increased blood flow and oxygen to the digestive system, which helps the GI tract to function in a more rhythmic way,” says Kinsinger, who is also an associate professor at Chicago’s Loyola University Medical Center.

CBT also involves thought restructuring. IBS can cause a cycle of worry: Worrying about symptoms leads to being hyperfocused on the slightest hint of any symptom, which increases anxiety, which aggravates symptoms. People with IBS also often catastrophize, meaning they assume the worst will happen (“If I have an accident at work, I’ll get fired and never get another job”), develop social anxiety and become withdrawn. CBT addresses these issues by shifting attention away from IBS symptoms and using exposure therapy to help people gradually engage in more activities outside their homes.

Additionally, using CBT, people with IBS learn to identify and change dysfunctional ways of thinking. For example, consider someone with school-aged children who asks their spouse to attend all school functions because they’re afraid of farting in a room with other parents, which would inevitably cause humiliation and might even make people think they’re disgusting A therapist might ask them how often they notice bodily noises from other people to help them realize that we’re a lot more cognizant of our own bodily functions than other people are. “In other words, we identify the catastrophic beliefs and then search for evidence supporting them or not,” Hunt says.

CBT is a skills-based, goal-oriented approach to treating mental disorders that emerged in the mid-20th century. All CBT programs share the same underlying goal of helping patients identify and modify negative or unhelpful thought patterns and behaviors. “It teaches patients techniques that they can then implement on their own.” says Kinsinger. “It can be done pretty efficiently, depending how motivated and receptive one is to learning these skills.” But over time, customized versions of CBT have been developed for specific conditions including insomnia, schizophrenia and IBS. Different versions of CBT use different techniques, such as role-playing, exposure therapy and relaxation exercises, and vary in length. On average, CBT for IBS lasts between 4 and 10 sessions in total.

Jeffrey Lackner, professor and chief of the division of behavioral medicine at the University at Buffalo, SUNY, says their program is structured like a course: “You learn a specific skill to manage your GI symptoms, process information differently or respond to stress in a less extreme way. Then you practice that skill in session before using it in the real world.” Often therapists also give patients homework to fine-tune the skills they learn. They come out of CBT with a toolbox of techniques to manage the day-to-day burden of IBS.

Some people with IBS do CBT on their own, using self-help books, online materials or apps without ever seeing a therapist. “Not many psychologists are trained to treat GI disorders specifically, so physicians don’t often have anyone to refer patients to,” Kinsinger says. The Rome Foundation trains psychologists and maintains a directory of gastrointestinal psychologists, but if someone can’t find a provider in their area, Hunt and Kinsinger recommend looking for a psychologist who’s trained in CBT and has experience treating chronic pain, panic disorders or anxiety.

Reducing sensations vs. reducing sensitivity

Not everyone is fully on board with CBT for IBS. One 2018 review study found “insufficient evidence to demonstrate the effectiveness of online CBT to manage mental and physical outcomes in gastrointestinal diseases” including IBS. A different 2018 review concluded that although psychological treatments for IBS appear to help in clinical trials, it’s unclear if they work in other settings and which treatments — such as CBT, mindfulness-based stress reduction and guided affective imagery — are most effective.

IBS is a complex problem, and some doctors prefer to integrate CBT with other treatments. But “by the time we see them,” Lackner says, “many of our patients have found that the medical treatments have not provided adequate symptom relief.”

Some IBS patients also find thetraditional approaches too hard to stick with. The most commonly prescribed treatment is a “low-FODMAP” diet, which requires giving up all dairy and legumes, plus many grains, fruits and vegetables. “Some trials show that even if the diet reduces or eliminates GI symptoms, it doesn’t improve quality of life because it’s crazy restrictive,” Lackner points out.

“With IBS, the nerve endings in the gut have become hypersensitized, and the brain magnifies those signals in the gut,” Hunt says. “The low-FODMAP diet tries to reduce the sensations, whereas CBT reduces the hypersensitivity. When you turn down the volume on the sensations, then you can eat whatever you want.”

Whether CBT helps with this brain-gut dysregulation, addresses distorted thinking and anxiety, or increases confidence in a person’s ability to manage gastrointestinal symptoms — or all of the above — it’s helped people with IBS resume parts of their life they’d put on hold.

Brittany Risher is a writer, editor and digital strategist specializing in health and lifestyle content. She's written for publications including Men's Health, Women's Health, Self and Yoga Journal.

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